Description: Legislative barriers to enacting single-payer healthcare reform, even in states with strong majority support, have led many advocacy groups to consider or attempt binding ballot initiatives to win health care as a right. However, getting on the ballot and winning is not necessarily easier than advancing legislation, and offers a distinct set of challenges. This workshop discusses lessons from initiatives in the past, and what it will take to get to single-payer through the ballot.

Notes from Conference Participants:

Peter Shapiro's Presentation Notes on Oregon Ballot Measure 23:

1. Clarify that this is based mainly in Mark Lindgren’s sum-up, written several weeks after the November 2002 election. I was not involved at that time. Clarify also that the “Health Care for All Oregon” that did the ballot initiative was actually a different organization than the current incarnation. By 2011, when a new statewide coalition was being formed, the old HCAO was largely moribund. Some of its activists encouraged us to expropriate its name, which we did.

2. This is not a particularly happy story. Measure 23 was clobbered. Objective conditions today are a lot more favorable, not least because there’s the beginnings of a sea-change in organized labor’s attitude toward health care reform—due to the continuing meltdown of the health care system, the increasing difficulty of negotiating union health benefits, and the real dangers and shortcomings of Obamacare.

3. Nevertheless, any attempt to win single payer at the state level through a ballot initiative is going to face some of the same obstacles that defeated Measure 23, so it’s worth looking at them and thinking about whether they could be overcome, and how.

4. Measure 23 was almost entirely the work of committed and energetic volunteers. It had no real institutional support, from organized labor or anyone else, though it was endorsed by the Oregon Democratic Party, Ecumenical Ministries, the Consumers Union, PNHP, and NOW (and, I’m proud to say, my own union). Volunteers were responsible for drafting, fundraising, and most of the signature gathering. (Professional signature gatherers were hired late in the game.)

5. Michael Dembrow’s point about legislative vs. initiative process. Drafting state legislation is complex—-issue of federal waivers, financing, residency requirements, schedule of benefits, etc. etc. A bill can always be fine-tuned as stakeholders weigh in on it, but once an initiative is on the ballot measure is on the ballot, you’re stuck with it.

6. HCAO attempted to involve organized labor in the drafting process, but (perhaps because it lacked a strong enough union presence in its own ranks) it didn’t get Tim Nesbitt’s attention till it was on the ballot. Then it got entirely too much attention from him, of which more later.

7. The initiative was a truly grass roots, seat of the pants operation. It raised $90,000 all told, $55,000 of which went to get it on the ballot. Of that, about $27,000 went for paid signature gatherers. That left $35,000 to do the actual campaign. Shortage of funds prevented any polling by the campaign, or any analysis of how costs of the measure would be borne. Legislative Revenue Office was swamped with work and did not come up with its own numbers until it was too late to be of use.

8. When an October 11 poll showed the measure in a dead heat with 25% still undecided, the insurance industry got worried. In the closing weeks of the campaign they spent $1.2 million, much of it out of state money, to defeat it. Their approach can be divined from the name of their front group, “Oregonians Against Unhealthy Taxes.” Their line was that Measure 23 would cost a fortune to implement, encourage freeloaders (including, presumably, undocumented) to come to Oregon to take advantage of it) create demand for unnecessary treatment (including alternative therapies), result in rationing and physicians fleeing the state because of poor compensation.

9. Move to Amend would probably disagree, but my feeling that being outspent doesn’t have to be decisive—there are plenty of examples around the country where progressives have prevailed despite being targeted by the Koch brothers. But you have to lay the groundwork before you go to the ballot, with patient organizing and public education. An electoral campaign is not a good substitute.

10. What really killed Measure 23, however, was when the Oregon AFL-CIO came out against it on the grounds that its funding formula was regressive and would force union workers to pay more for health benefits that were currently borne by employers. Tim Nesbitt claimed that that employers would bear 53% of the cost burden and employees 43%, far more than they were paying under most union contracts. Ken Allen: “If an employer brought this kind of cost-shift to the bargaining table, we’d be on strike for a long time.”

11. A lot has changed since 2002. For one thing, Oregon AFL-CIO voted at its convention last summer to join HCAO, with Jeff Klatke and John Mohlis leading the charge on the convention floor. Although resolution did contain human rights language, its main emphasis was economic.

12. Nevertheless, there is a world of difference between going on record in support and committing to a statewide campaign. Example of SEIU and meeting with its state political director. Generally unions are reluctant to invest resources and political capital in a campaign unless they’re reasonably confident about its chances.

13. The organizational question: currently HCAO is (formally) a coalition with over 100 member organizations. But it runs, as ever, largely on volunteer labor.